Incidence, Risk Factors, and Survival of Hepatocellular... : Hepatology (original) (raw)

Autoimmune, Cholestatic and Biliary Disease

Incidence, Risk Factors, and Survival of Hepatocellular Carcinoma in Primary Biliary Cirrhosis

Comparative Analysis from Two Centers†

Cavazza, Anna1,‡; Caballería, Llorenç1; Floreani, Annarosa2; Farinati, Fabio2; Bruguera, Miquel1; Caroli, Diego2; Parés, Albert1,*,§

1 Liver Unit, Digestive Diseases Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, IDIBAPS, Barcelona, Spain

2 Department of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy

*Address reprint requests to: Liver Unit, Hospital Clínic, C/ Villarroel 170, 08036-Barcelona, Spain

E-mail:[email protected]

Received 4 February 2009; Accepted 18 May 2009.

Published online in Wiley InterScience (www.interscience.wiley.com)..

Grant sponsor: CIBEREHD, Instituto de Salud Carlos III, Spain.

†Potential conflict of interest: Nothing to report.

‡Dr. Cavazza was the recipient of an Erasmus Grant during her last year in medical school, carried out at the Liver Unit, Hospital Clínic, University of Barcelona.

§fax: +34 93 4515522

Abstract

The limited information and divergent results on the prevalence, incidence, and risk factors for hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) may be due to the low prevalence of the disease and geographical and environmental differences. Therefore, we analyzed the incidence, prevalence, survival, and risk factors for HCC in patients with PBC from two European centers (389 from Barcelona, Spain, and 327 from Padova, Italy) followed up for 9.3 ± 6.5 years. Gender, age, smoking habit, alcohol consumption, presence of hepatitis B surface antigen (HBsAg) or hepatitis C virus antibodies (anti-HCV), and advanced histological stage (III-IV) were evaluated as risk factors for tumor development. Twenty-four patients (13 from Barcelona and 11 from Padova) developed HCC. The prevalence of HCC was similar in Barcelona (3.34%) and Padova (3.36%). The incidence was 0.35 and 0.37 per 100 patient-years, respectively. Male gender, age >52 years, smoking habit, alcohol >40 g/day, HBsAg, and anti-HCV were not associated with HCC. Advanced histological stage was the only factor associated with the development of HCC (odds ratio [OR]: 5.80, 95% confidence interval [CI]: 2.34-14.38, P < 0.001). When analyzing the two series separately, male gender was associated with higher likelihood of HCC in Padova (OR: 8.09, 95% CI: 1.93-33.8, P < 0.01). The median survival after the diagnosis of HCC was 36 months.

Conclusion:

The prevalence and incidence of HCC is similar in Spain and Italy and the advanced histological stage is the only risk factor associated with the development of HCC in PBC. The slight disparities observed between the two series might be explained by patient features on diagnosis of liver disease. (Hepatology 2009.)